Thursday, May 5, 2011

First Day

Well, I've safely arrived in Eldoret. After four flights and 36-odd uneventful hours of travel, I arrived at IU house as a total zombie yesterday. After a tour, a nap, dinner, and a good night's sleep I felt significantly more human today. Good thing, since we started on the wards bright and early.

As a resident, one experiences a lot of "first days." Every month brings a new rotation, and it's essentially starting a new job every month: new patients, new attendings, new co-workers, new expectations. In some ways it's refreshing - if things get bad, hey, it's only a month, right?
Sometime around the beginning of this year (my third of residency) the "night before" jitters started to get a little better. I'd finally figured out how to figure things out at all of the hospitals where I work, or at least who to ask. Here, not so much.

The day started with morning report, today's topic was put on by the IU OB/Gyn residents. Following that I started rounding with the medicine team. The medicine wards are divided into a men's ward and a women's ward, and each has two team. I joined a team that was already well into rounds on the women's side (per Laura, one of the team leaders, it's the "less smelly"), and caught the last few patients. "Major Ward Rounds," ie, rounds with a consultant (attending) take place twice a week. Our patients were varied - a 50some woman with HIV and respiratory distress, but we couldn't narrow it down any further since the chest xray machine wasn't working, a teenager with low blood counts for unclear reasons, who will probably get a bone marrow aspirate in the next few days, several with altered mental status. Following rounds, the consultant quickly departed, and the registrar also had to leave, which left the post-call intern, Shamsa, with all the work, and the resident assuring her that I would be able to help. (Just to be clear - I'm not much help)

I quickly realized that some parts being an intern in Kenya aren't so different after all. From scraps of paper with lists and check-boxes to a seemingly endless series of phone calls, internship is always about being the one to do the work no one else wants to do. However, when the psychiatry consultant showed up he expected Shamsha to write all of his notes as he dictated them. In addition to that, she had to stay until 5pm post call and continue admitting patients.

Not too long after rounds, we responded to my first Kenyan "resuscitation." A patient who had been on the wards for about a week, HIV positive, confused and spiking fevers despite treatment for meningitis, had continued to decline. The family had donated blood on Sunday, but it wasn't able to be processed until today, and she looked quite bad on rounds. She had just started getting the blood when one of the nurses noted that she was longer breathing and had no pulse. Shamsha responded, started doing CPR while I bagged the patient, and one round of adrenaline and hydrocortisone was given without any response, and Shamsha pronounced the patient dead. The resuscitation was obviously less than would be done at a code in the States, but also more than I expected than could be done here.

Following that, there was still much work to be done - a periotoneal (abdominal fluid) tap, several lumbar punctures, and several new admissions to see, and deciding which of the two available antibiotics to start them on. I was happy that I could remember enough Kiswahili to understand most of the patient interviews, though my vocab is lacking that I can't quite carry one out myself.

Tomorrow should be interesting - to see what parts of our plans actually happened, and what other new patients come in overnight. I'll try to keep you updated tomorrow, especially now that I've completely broken my promise not to use to much medicine jargon. I think we are going on a brief sarfari to Lake Nakuru this weekend, so I will make up for it by posting pictures of rhinos and hippos and flamingos for the rest of you.

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